Non-sedating barbiturate compounds as neuroprotective agents

ABSTRACT

Methods of providing neuroprotection are disclosed comprising administering a non-sedative barbiturate compound in an amount sufficient to achieve neuroprotection in a mammalian subject. Preferred compounds are in the family of diphenylbarbituric acid and analogs. Preferred doses for a neuroprotective effect exceed the dosage of a corresponding sedative barbiturate without sedative side-effects such as anesthesia and death.

This application is a continuation of U.S. patent application Ser. No.10/865,428 filed Jun. 10, 2004 which is a continuation of U.S. patentapplication Ser. No. 10/333,957, filed Jan. 27, 2003, now U.S. Pat. No.6,756,379 which claims the benefit under 35 U.S.C. §371 ofPCT/US01/23420, filed Jul. 26, 2001 which claims priority under 35U.S.C. §1.119(e) of Provisional Application Ser. No. 60/221,672, filedJul. 26, 2000, the disclosures of which are incorporated by reference intheir entireties herein.

BACKGROUND OF THE INVENTION

The invention relates to the use of non-sedating barbiturate compoundsgiven in a manner and dosage effective to produce blood levels and brainlevels of these drugs and/or their active metabolites sufficient toprovide a neuroprotectant effect. In particular, the methods andformulations of the invention permit treatment of cerebral ischemia,head trauma and other acute neurologic injuries, and prevention ofresulting neuronal damage.

Ischemia (stroke) is the third leading cause of death in the UnitedStates. When blood supply to the brain is reduced below a criticalthreshold, a cascade of biochemical events leads to irreversible damageto neurons and brain infarction. Research on treatment and prevention ofischemia is extensive but unfortunately it remains at a basic stage andno adequate therapies are yet in practice (10).

Barbiturates in high concentrations have been shown to beneuroprotective in cerebral ischemia in rodents and primates, to reducethe extent of ischemia brain infarction, and to prevent or lessen braindamage (1-4). One theory as to how barbiturates prevent neuronal injuryin ischemia is that they inhibit the ischemia-induced uncontrolledrelease of neurotransmitters, which can attain high, neurotoxicconcentrations that cause neuronal death (5).

The literature regarding the neuroprotective effects of anestheticbarbiturates is over two decades old, but the clinical use ofbarbiturates has been severely limited because of toxicity. The dosagesand blood and brain levels necessary to confer neuroprotection are toxicand cause lethargy, stupor, and coma. Even higher doses that might bemore effective are lethal (1-4, 6), making barbiturates unsuitable fortreatment of ischemia (1). These toxic side effects establish a“functional ceiling” on dosage for barbiturates, and have discouragedfurther research into the use of anesthetic/sedative barbiturates toprotect from ischemia.

Levitt et al., U.S. Pat. No. 4,628,056 describes non-sedatingoxopyrimidine derivatives and their use as anticonvulsants, anti-anxietyand muscle relaxant agents. The literature does not suggest the use ofsuch compounds as neuroprotectant agents. Indeed, even in publishedstudies about using sedative barbiturates for neuroprotection there isno reference to non-sedating barbiturate compounds. It is generallybelieved that the anticonvulsant and neuroprotective effects ofbarbiturates are linked to their sedative/hypnotic effects. For example,Lightfoote et al. suggested that the protective effects of pentobarbitalare due to the duration of the barbiturate-induced anesthesia (3). Thisviewpoint has been reinforced by biochemical studies at the cellreceptor level that relate all these effects to action at the GABAreceptor. Thus, the prior art teaches away from using sedativebarbiturates for neuroprotection because of their toxicity, and alsoteaches away from using non-sedative barbiturates as neuroprotectantsbecause they lack sedating or anesthetic properties.

SUMMARY OF THE INVENTION

In summary, the invention involves non-sedating barbiturates such as forexample 1,3-dimethoxymethyl 5,5-diphenyl-barbituric acid (DMMDPB),1-monomethoxymethyl 5,5-diphenylbarbituic acid (MMMDPB) anddiphenyl-barbituric acid (DPB) and their precursors, derivatives andanalogs, and their administration over a range of dosages that result ina range of blood levels and brain levels of these drugs and theirmetabolites making them useful as neuroprotectants. In particular, theinvention is directed to the treatment of cerebral ischemia, head traumaand other acute neurologic injuries, using non-sedating barbiturates.

There are many circumstances where individuals at risk of cerebralischemia are clearly identified in advance, for example: individualsundergoing cardiac surgery or carotid endarterectomy, and individualswith atrial fibrillation, transient ischemic attacks (TIAs), bacterialendocarditis, strokes, or subarachnoid hemorrhage due to a cerebralaneurysm. In such cases, a non-sedating barbiturate is usedprophylactically in individuals at risk for ischemic damage. The drugscan also be used after an acute event. These compounds can be given inoral form as a tablet, capsule, liquid or via intravenous or otherparental routes.

This invention succeeds where previous efforts to treat cerebralischemic attack with barbiturates have failed. This invention solves aproblem previously thought to be insoluble, that of toxic effects ofneuroprotective dosages of barbiturates. The invention avoids thetoxicity and sedative effects of barbiturates known in the prior artwithout loss of efficiency.

This invention satisfies a long-felt need for a non-toxicneuroprotectant, and is contrary to the teachings of the prior artregarding the inability of barbiturates to produce clinically meaningfulneuroprotection. According to the invention, it is possible to separatethe anticonvulsant and sedative effects of barbiturates, andneuroprotection correlates much better with the anticonvulsant ratherthan the sedative effect of barbiturates.

This invention differs from the prior art in the recognition of specificcompounds, their modifications and dosages that are effective inneuroprotection but that were not previously recognized.

The present invention is a method for providing neuroprotection to amammal, preferably a human. The method comprises administering to themammal a non-sedating barbiturate in a dose effective to provide aneuroprotection effect. Non-sedating barbiturates for use in theinvention include one or more selected from the group consisting of1,3-dimethoxymethyl 5,5-diphenyl-barbituric acid (DMMDPB),1-monomethoxymethyl 5,5-diphenylbarbituric acid (MMMDPB), and diphenylbarbituric acid (DPB). The precursors, derivatives and analogs of theforegoing compounds, as well as the salts of all the foregoing are alsosuitable for practicing the invention.

The effective neuroprotective dose of the non-sedative barbituratepreferably exceeds the coma-producing dose of a sedative barbiturate.Depending on the specific need of the mammal, the dose of thenon-sedative barbiturate may exceed a dose that would be lethal with asedative barbiturate. This unexpected and seemingly paradoxical effectof the present method is further reflected in the relative dosage levelsthat are possible with the methods of this invention.

Also, the neuroprotective dose of the non-sedative barbiturate exceedsthe minimum anticonvulsant dosage of the barbiturate. In someembodiments of the present invention the effective dose of thenon-sedative barbiturate is in the range of from about 2 times to about5 times the anticonvulsant dosage. In yet other contexts where the needof the mammal requires, the effective dose of the non-sedativebarbiturate is in the range of from about 5 times to about 10 times theanticonvulsant dosage of the non-sedative, or even higher so long as thedose is clinically acceptable.

Advantageously, the neuroprotective effect of the present methods can beused to mitigate the effect of cerebral ischemic. The non-sedatingbarbiturate can be administered orally, intravenously, transdermally, incombination with an adjuvant, or transpulmonarily by means of aparticulate or aerosol inhalant. Moreover, within the scope of theinvention, the non-sedating barbiturate can be administeredpreventively, prophylactically or therapeutically, at a clinicallyacceptable dose. The compound may be administered prophylacticallybefore evident neuronal damage, or therapeutically after onset ofneuronal damage. The neuroprotective effect diminishes, or protects thesubject from, neuronal damage caused by head trauma or cerebralischemia. The compound may be administered in conjunction with cardiacsurgery or carotid endarterectomy. The mammalian subject may have or beat risk for atrial fibrillation, a transient ischemic attack (TIA),bacterial endocarditis, a stroke, head trauma, or subarachnoidhemorrhage.

Typically, to achieve neuroprotection the non-sedating barbiturate isadministered in a dose sufficient to obtain blood concentrations of atleast about 30 μg/ml of barbiturate, preferably at least about 100μg/ml, more preferably at least about 250 μg/ml, and possibly as high as200-300 μg/ml, or even higher. In contrast, the reported therapeuticrange for phenobarbital is lower, 10-30 μg/ml blood levels (6). Thus,preferred ranges are at or above about 25, 30, 50, 75, 100, 200, 250, or300 μg/ml.

The invention includes a pharmaceutical composition comprising anon-sedating barbiturate administered in an amount effective to have aneuroprotectant effect. Preferably, the non-sedating barbiturate isadministered in oral doses in the range of from about 25 to about 1,500mg/kg/day body weight. Preferably the dose is greater than about 25mg/kg/day, or greater than about 100 mg/kg/day, or greater than 250mg/kg/day. A preferred dose is one that is pharmacologically equivalentto a dose of about 1000 mg/kg/day in the rat. Thus, dosage forms may besufficient individually or in multiple doses to provide a dose equal toor above about 15, 20, 25, 50, 70, 100, 250, 500, 1000, or 1500 mg/kgbody weight per day.

In human trials it has been unexpectedly found that DMMDPB, one of theneuroprotectant compounds, is much better absorbed in humans than inrats or dogs. It has further been found that the half life of DMMDPB, aswell as the half life of MMMDPB and DPB are greater than the half-livesfound in rats or dogs. Specifically, with dosages of 20 mg/kg/day, thehalf-lives of DMMDPB, MMMDPB, and DPB are approximately 20 hrs, 20 hrs,and 50 hrs respectively after a two week exposure in humans. Similarly,the maximum concentration (Cmax) of the drug in the blood following 7days of dosing in the range of 20 mg/kg/day are 1.2 μg/ml, 36 μg/ml and43 μg/ml respectively.

The unexpectedly high absorption and prolonged half-life in humans makesit possible to achieve substantial blood levels with lower than expectedoral dosages. Thus, for example, it is possible to obtain totalbarbiturate blood levels (i.e., DMMDPB+MMMDPB+DPB)>53 μg/ml with dosagesof about 15 mg/kg/day; and total barbiturate levels >72 μg/ml withdosages in the range of 20 mg/kg/day. Blood levels of non-sedatingbarbiturates greater than 100 μg/ml are achieved with dosages betweenabout 40 and about 100 mg/kg/day, and are within the scope of theinvention. With parenteral administration of non-sedating barbiturates,similar blood concentrations are obtained with daily dosages of lessthan 25 mg/kg/day. However, first day loading dosages may still needinitial dosages of greater than 25 mg/kg.

The invention provides an article of manufacture comprising a containercomprising a pharmaceutical composition and a label with indications foruse as a neuroprotectant, the pharmaceutical composition comprising anon-sedating barbiturate compound in an amount effective forneuroprotection upon administration to a subject in need ofneuroprotection; and a pharmaceutically acceptable carrier or excipient.

Another embodiment is a method for providing neuroprotection comprising(a) diagnosing a patient's need for cerebral neuroprotection, (b)selecting a non-sedative barbiturate, and (c) providing to the patient adose of the non-sedative barbiturate sufficient to raise theconcentration in the patient's brain to a level effective to provideneuroprotection.

Further objectives and advantages will become apparent from aconsideration of the description and examples.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

In describing preferred embodiments of the present invention, specificterminology is employed for the sake of clarity. However, the inventionis not intended to be limited to the specific terminology so selected.It is to be understood that each specific element includes all technicalequivalents which operate in a similar manner to accomplish a similarpurpose. Each reference cited here is incorporated by reference as ifeach were individually incorporated by reference.

The term “non-sedative barbiturate” encompasses the family of5,5-diphenyl barbituric acid anticonvulsant compounds described inLevitt et al., U.S. Pat. No. 4,628,056, and metabolic precursors andmetabolites, and derivatives and structural analogs (including additionsalts thereof) having a non-sedative neuroprotectant activity. Otherbarbituric acid derivatives that are non-sedating are also within thescope of the invention.

Derivatives, precursors, and analogs of barbituric acid includebarbituric acids of the formula:

wherein one or more nitrogen is substituted with lower alkyl, or a loweralkoxy substituted lower alkyl group; or at least one of R¹ and R²,together with the nitrogen, forms a carbamate, an amide, or an acetal ofthe formamide derivative, i.e. R¹ or R² is CO₂R, COR or CH(OR)₂.Methylether groups are preferred R¹ and R² groups and methoxymethyl ismore preferred. Methyl is also a preferred value for R¹ and/or R². Otherderivatives of barbituric acids according to the invention arecarbamates, amides and acetals where one or both of R¹ and R² is CH₂OR⁵,wherein R⁵ is lower alkyl, alkylaryl or benzyl; CO₂R⁶, wherein R⁶ islower alkyl or aryl; COR⁷, wherein R⁷ is hydrogen, lower alkyl or aryl;or CH(OR⁸)₂, wherein R⁸ is a lower alkyl group.

Preferred values for R³ and R⁴ are aryl, phenyl, phenyl substituted witha halogen or lower alkyl group, benzyl, benzyl wherein the aromatic ringis substituted with a halogen or lower alkyl group, lower alkyl or loweralkyl substituted with an aromatic moiety. Aryl represents anycarbocyclic ring, such as phenyl, naphthyl and higher analogues, as wellas heteroaromatic rings substituted with one or more heteroatoms such assulfur, oxygen and nitrogen. According to the invention, nonsedatingbarbituric acid derivatives are those where at least one of R³ and R⁴ isan aromatic ring or an aromatic ring containing moiety e.g. aryl,phenyl, substituted phenyl, benzyl, substituted benzyl or arylalkyl.Preferred substituents on the aromatic rings are methyl, ethyl, andfluorine. Phenyl and substituted phenyl are preferred for R³ and R⁴.Embodiments where R³ and R⁴ are both phenyl are most preferred.

In preferred compounds, one of R¹ and R² is hydrogen, or one or both ofR¹ and R² is methyl or alkoxymethyl, preferably methoxymethyl. At leastone and preferably both of R³ and R⁴ is preferably phenyl or substitutedphenyl, tolyl, fluorophenyl, ethylphenyl.

As can be readily understood, salts of the above compounds are alsocontemplated, including organic salts, such as acid addition and baseaddition salts.

In order to fall within the scope of this genus, the compound must (1)be a barbituric acid chemical derivative, (2) not be sedating, in thesense that the subject remains awake and alert at useful doses, that is,not anesthetized, and (3) manifest neuroprotective activity in an animalmodel described herein or in a human at a dose that is not toxic to therelevant animal species, or show activity in an in vitro assay now knownor later discovered that is accepted as a model for in vivoneuroprotection.

These barbituric acid derivatives may be both prodrugs and activeingredients in the subject, thus combining to produce the desiredpharmacodynamic effect of neuroprotection. Sustained levels are readilyobtained with such compounds.

Thus, certain barbiturate compounds have been developed and haveanticonvulsant activity without being sedating even at very high brainconcentrations (that would be lethal with other barbiturates). Accordingto the invention, such compounds are used to neuroprotect an animal atrisk for or suffering from one or more ischemic episodes such as thatmodeled by middle cerebral artery occlusion, while these compounds donot cause the toxic effects of other barbiturates when present atconcentrations required for prevention of ischemic brain damage.

As described herein, non-sedative barbiturate drugs lessen or preventischemic brain damage in a rat model of focal cerebral ischemia producedby middle cerebral artery occlusion. This demonstrates utility inhumans.

In a reproducible, predictive model of cerebral ischemia known in theart, selective neuronal damage is produced in the striatum and cerebralcortex by bilateral carotid occlusion accompanied by systemichypotension. The resulting cerebral ischemia causes a release ofexcitotoxic neurotransmitters and dopamine in striatum. Pentobarbitalinhibited this ischemia-induced release, pointing to one possiblemechanism of barbiturate neuroprotection. (5) A neuroprotective dose ofpentobarbital was found to be 70 mg/kg. Inhibition of neurotransmitterrelease by several neuroprotective anesthetic agents (isoflurane,etomidate, propofol) was also known.

The above and similar animal models (see Examples) can be used

-   (1) to analyze whether a non-sedative barbiturate with    anticonvulsant properties but little or no anesthetic activity can    provide neuroprotection in the striatum or hippocampus, and-   (2) to determine if the agent prevents or reduces release of    neurotransmitters in response to ischemia. Uncontrolled or    unmodulated neurotransmitter release is one of the postulated    mechanism of ischemic damage. For non-sedating barbiturates that    inhibit release of neurotransmitters, this approach can serve as a    biochemical assay for predicting utility of a compound according to    the invention, and the invention encompasses such methods.

A neuroprotective effect according to the invention can be demonstratedand characterized by performing a dose-response study and measuringstatistically significant differences in neuronal damage at the variousdoses of the drug. Dose-response curves generated in such studies can beused to compare the relative degree of neuroprotection and sedation of atest compound.

Cerebral ischemia is induced in rats by occlusion of the middle cerebralartery (“MCA”) (7-9). The occlusion can be performed in an irreversibleor reversible manner. In the latter case, after a period of obstruction,blood flow is restored. These animal preparations are thus appropriateto model various types of strokes in humans and to permit determinationof a drug's neuroprotective action. Such models permit observation ofthe prevention of brain damage and the evaluation of the drugs as beinguseful for humans who are at risk for ischemic stroke for reduction ofsubsequent brain damage induced by an ischemia event. Because theyprevent brain damage in models of irreversible ischemia and reversibleischemia with restoration of blood flow, the compounds of the inventionare also useful for treating acute ischemic stroke either alone or incombination with other agents, for example, thrombolysins such as tissueplasminogen activator that reduce the extent of brain infarction whencirculation is restored.

The term “treatment” is intended to encompass administration ofcompounds according to the invention prophylactically to prevent orsuppress an undesired condition, and therapeutically to eliminate orreduce the extent or symptoms of the condition. Treatment according tothe invention is given to a human or other mammal having a disease orcondition creating a need of such treatment. Treatment also includesapplication of the compound to cells or organs in vitro. Treatment maybe by systemic or local administration.

The non-sedative barbiturate compositions of the present invention, maybe formulated into “pharmaceutical compositions” with appropriatepharmaceutically acceptable carriers, excipients or diluents. Ifappropriate, pharmaceutical compositions may be formulated intopreparations including, but not limited to, solid, semi-solid, liquid,or gaseous forms, such as tablets, capsules, powders, granules,ointments, solutions, suppositories, injections, inhalants, andaerosols, in the usual ways for their respective route ofadministration.

Methods known in the art can be used to achieve time-release of thecomposition or to prevent metabolism, release or absorption of thecomposition until it has reached its intended target site. Apharmaceutically-acceptable formulation should be employed that does notinactivate the active drug of the present invention.

In pharmaceutical dosage forms, the compositions may be used alone or inappropriate association, as well as in combination with, otherpharmaceutically-active compounds.

The pharmaceutical compositions of the present invention can bedelivered via various routes and to various sites in an animal body toachieve the desired neuroprotective effect. Local or systemic deliverycan be accomplished by injection, infusion, application or instillationof the composition into one or more body cavities, or by inhalation orinsufflation of an aerosol. Parenteral administration can be byintramuscular, intravenous, intraperitoneal, subcutaneous intradermal,or topical administration.

The compositions of the present invention can be provided in unit dosageform, wherein each dosage unit, e.g., a teaspoon, tablet, solution, orsuppository, contains a predetermined amount of the active drug orprodrug, alone or in appropriate combination with otherpharmaceutically-active agents. The term “unit dosage form” refers tophysically discrete units suitable as unitary dosages for human andanimal subjects, each unit containing a predetermined quantity of thecomposition of the present invention, alone or in combination with otheractive agents, calculated in an amount sufficient to produce the desiredeffect, in association with a pharmaceutically-acceptable diluent,carrier (e.g., liquid carrier such as a saline solution, a buffersolution, or other physiological aqueous solution), or vehicle, whereappropriate. The specifications for the novel unit dosage forms of thepresent invention depend on the particular effect to be achieved and thedrug's particular pharmacodynamics in the particular host.

An “effective amount” of the composition is that required to produce thedesired pharmacologic effect in a host. This can be monitored using anyof a number of end-points known to those skilled in the art. The“effective dose” will depend on the bioavailability of specific dosageforms delivered by one or another route of administration. Theneuroprotective dosage and blood level of the present compounds is atleast 2-fold and preferably at least about 5 to 10-fold theanticonvulsant dosage of a sedating barbiturate. Based on rat data, theanticonvulsant ED₅₀ for phenobarbitol is about 50-100 mg/kg. Anon-sedating barbiturate dose of 1 g/kg given over 7 days protectsagainst cerebral ischemia in the rat. Similar or lower doses aresuitable in humans based on the enhanced absorption in humans discussedabove.

The amount of each active agent employed in the Examples below providesgeneral guidance for the range that can be utilized by the skilledpractitioner to optimize the doses and methods of the present invention.Moreover, such dose ranges do not preclude use of a higher or lower doseof a component, as might be warranted in a particular application. Forexample, the actual dose and schedule may vary depending on whether thecompositions are administered in combination with other drugs, ordepending on inter-individual differences in pharmacokinetics, drugdisposition, and metabolism. Similarly, amounts may vary for in vitroapplications. It is within the skill in the art to readily adjust thedose in accordance with the necessities of a particular situationwithout undue experimentation Having now generally described theinvention, the same will be more readily understood through reference tothe following examples which are provided by way of illustration, andare not intended to be limiting of the present invention, unlessspecified.

EXAMPLE 1 General Design

The non-sedative barbiturate (NSB) drug is tested in rats exposed toeither reversible or irreversible ischemia. Varying doses of drug areadministered. The neuroprotective effect is compared to a negativecontrol (placebo) and a positive control, pentobarbital, a knownneuroprotective but sedative barbiturate, given at doses known to reduceinfarct volume in cerebral ischemia (1-4).

Animals are sacrificed several days after the onset of the ischemicinsult and the brains examined to determine the volume of braininfarction as an outcome measure of the drug's reduction of ischemicbrain damage. The animals are examined clinically and graded prior tosacrifice to determine if the drug has conferred any beneficial effecton relevant functions following ischemic “stroke.”

Four experimental models are preferred for testing the neuroprotectiveeffects of the NSB drug. See Ginsberg, M. D., “Animal Models of Globaland Focal Cerebral Ischemia,” Chapter 34 in Welsh, K. M. A et al.,Primer on Cerebrovascular Diseases, Academic Press, New York, 1997; andPulsinelli W A, Brierley J B. A new model of bilateral hemisphericischemia in the unanesthetized rat, Stroke 1979 May-June 10(3): 267-72.

-   -   1. Irreversible ischemia produced by middle cerebral artery        (MCA) occlusion;    -   2. Reversible ischemia produced by MCA occlusion;    -   3. Transient global ischemia produced by cross-clamping the        aorta for a defined interval; and    -   4. Transient global ischemia produced by cauterizing both        vertebral arteries and reversibly clamping the common carotid        arteries.

In each experimental model, groups of rats are treated with either:

-   -   1. Negative control (placebo) via nasogastric (NG) tube;    -   2. Positive control: intraperitoneal (IP) dose of 70 mg/kg        pentobarbital; or    -   3. The NSB compound DMMDPB (or a compound being tested for its        utility in the present invention) via NG tube at doses between        500 mg/kg and 1500 mg/kg for 7 days prior to experimental        infarctions.        The results are compared.

EXAMPLE 2 Irreversible Cerebral Ischemia

Irreversible MCA occlusion was produced by ligating the carotid arteryand then inserting a filament into the origin of the MCA with the animalmaintained under halothane anesthesia. Blood flow in the MCA wasmeasured by laser doppler and those animals in which a significant dropin blood flow occurred were considered to have experienced cerebralischemia, and to be at risk for subsequent damage (i.e., a stroke).Indeed, no clinical strokes occurred in animals that did not experiencea precipitous drop in MCA blood flow. All the animals showing with adrop in MCA blood flow experienced strokes.

Animals at risk were then followed behaviorally and scored by clinicalfindings using the Bederson grading scale as either:

-   -   0 no evidence of stroke    -   1 mild stroke    -   2 moderate stroke    -   3 severe stroke

Those animals that survived for three days were sacrificed and theirbrains examined. Animals to be sacrificed were given chloral hydrate (35mg/kg IP, and their brains were fixed by intracardiac perfusion withheparinized 0.9% saline followed by 10% buffered formalin. The brainswere removed from the cranial vault with care to leave the arachnoidintact with the intracranial vessels underneath. The fixed brains werefrozen at 80° C. Coronal sections 20 μm thick were cut at 400 μmintervals in a cryostat at −20° C., dried on a hot plate at 60° C.,fixed in 90% ethanol for 10 minutes and stained with hematoxylin andeosin (7). Infarcted brain is pale compared to the rest of the brain.The amount of infarcted brain was determined by microscopic inspectionof the brain sections and calculation of infarct volumes in mm³.

The results are shown in Tables 1 and 2 below. The numbers vary betweengroups because not all animals experienced a drop in MCA blood flow withthe procedure. All animals were treated with DMMDPB dosages of 1000mg/kg/day for 7 days.

TABLE 1 Effect of DMMDPB on Death due to Cerebral Ischemia DeathSurvival at Survival at Survival at Treatment Be- within 24 hr 48 hr 72hr Group havior n 24 hr n (%) n (%) n (%) Control Sedated 12 9 (75%) 3(25%) 2 (17%) 1 (8%)  (males) Pentobarbital Sedated 9 6 (67%) 3 (33%) 3(33%) 3 (33%) (males) DMMDPB Not 17 2 (12%) 15 (88%)  10 (59%)  8 (47%)sedated Males 14 2 (24%) 12 (76%)  7 (50%) 5 (36%) Females 3 0 (0%)   3(100%)  3 (100%)  3 (100%)

Other dose ranging studies in rats treated with DMMDPB for 7 daysestablished that female rats have substantially higher blood levels thanmale rats. Specifically, at a dosage of DMMDPB of 500 mg/kg the totalbarbiturate level in males was 59 μg/ml and females 170 μg/ml. At adosage of 1000 mg/kg the total barbiturate level in males was 77 μg/mland females 227 μg/ml; and at a dosage of 2000 mg/kg the totalbarbiturate level in males was 110 μg/ml and females 328 μg/ml. Thusfemales consistently had blood levels 250%-300% that of males at thesame dosage. This data shows a type of “dose response effect” or “bloodlevel response effect” whereby higher blood levels correlate to highersurvival in female rats in the results tabulated above.

TABLE 2 Neurologic status of the first 9 animals of Table 1 NeurologicStatus (Bederson Treatment Weight grading scale 0-3) group Rat# (g) Day1 Day 2 Day 3 Pathology Placebo 1 260 3 X Died 24 hrs 2 260 3 X Died 24hrs 3 240 3 X Died 24 hrs Pentobarbitol 1 260 0 1 1 SAH (autopsy) 2 2502 2 2 Brain collected DMMDPB 1 270 1 1 1 Brain collected 2 230 3 3 XDied 48 hrs 3 240 2-3 3 X Died 48 hrs 4 260 2-3 3 3 Brain collected

Pathology (visual and microscopic examination) shows smaller infarctvolumes in animals pretreated with pentobarbitol and DMMDPB.

Thus, DMMDPB proved to protect the animals against death. Other dataindicated that DMMDPB treated animals did not manifest sedation comparedto placebo group. In contract, the pentobarbital animals wereanesthetized and immobile. The neuroprotective effects at non-sedatingdoses were comparable to or better than the effects of the sedativepentobarbital but without the side effects-of sedation, particularly atday two.

These neuroprotective effects of DMMDPB are predictive formonomethoxymethyl diphenyl barbituric acid (MMMDPB) and the presumptivepharmacologically active chemical moiety diphenyl barbituric acid (DPB),which are metabolic products of DMMDPB. Indeed, in animal studies overperiods ranging from 1-30 days DMMDPB was rapidly metabolized to MMMDPBand eventually to DPB.

Results from clinical studies with humans demonstrated a pattern ofblood levels similar to that seen in animals: DPB>MMMDPB>DMMDPB. Again,the same pattern was shown in that blood levels of DMMDPB were minimal,while MMMDPB and DPB concentration was higher. This animal model ofneuroprotection is predictive for humans because: (a) the metabolicbehavior of this compound in animals is predictive of human metabolism,and (b) the anticonvulsant activity in animals correlates withanticonvulsant activity in humans.

Although several sedative barbituric compounds previously found to beneuroprotective in such animal models provided some benefit in humanstudies, their use over even relatively short time periods is precludedby their sedative and other neurological and psychological side-effects.These side effects make prophylactic treatment infeasible for patientsidentified as being at high risk of stroke. According to the presentinvention, in contrast, the NSBs have minimal side effects in humans.Thus, it is now established that diphenyl barbituric acid and itsprecusors, analogues and derivatives constitute a class or family ofcompounds suitable for neuroprotection of humans.

EXAMPLE 3 Reversible Cerebral Ischemia Model

Rats are pretreated as in Example 1 (above) and a similar procedure isperformed except that the filament occluding the MCA is removed after 30to 60 minutes, restoring blood flow through the MCA. Rats are thenfollowed clinically for three days, graded for their degree of strokeand then sacrificed as in Example. The brains are removed and examinedas described above.

The NSB compounds are shown to be neuroprotective under theseconditions.

EXAMPLE 4

Rats are pretreated as in Example 1 (above) and then, during etheranesthesia, the rats' vertebral arteries are electrocauterized throughthe alar foramina of the first cervical vertebra. Reversible clamps arethen placed loosely around the common carotid arteries. After 24 hours,working with awake rats, the carotid clasps are tightened to produce4-vessel occlusion. Following 10-30 minutes of 4-vessel occlusion, theclasps are removed and 72 hours later the animals sacrificed byperfusion fixation. Untreated rats routinely demonstrate ischemicneuronal damage after 20 or 30 minutes of 4-vessel occlusion. Multipleareas of the forebrain, including the H1 and paramedian hippocampus,striatum, and posterior neocortex are evaluated. The non-sedatingbarbiturates are shown to be neuroprotective under these circumstances.

The embodiments illustrated and discussed in this specification areintended only to teach those skilled in the art the best way known tothe inventors to make and use the invention. Nothing in thisspecification should be considered as limiting the scope of the presentinvention. The above-described embodiments of the invention may bemodified or varied, and elements added or omitted, without departingfrom the invention, as appreciated by those skilled in the art in lightof the above teachings. It is therefore to be understood that, withinthe scope of the claims and their equivalents, the invention may bepracticed otherwise than as specifically described.

REFERENCES

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1. A method for providing neuroprotection to a human in need thereofcomprising, administering a therapeutically effective amount of apharmaceutical composition of a salt of 5,5-diphenyl barbituric acid tothe human, wherein the human is undergoing cardiac surgery or carotidendarterectomy, or has had an atrial fibrillation, transient ischemicattacks (TIAs), bacterial endocarditis, ischemic stroke, or subarachnoidhemorrhage due to a cerebral aneurysm.
 2. The method of claim 1 wherein,the pharmaceutical composition of the salt of diphenyl barbituric acidis administered orally.
 3. The method of claim 2 wherein, thepharmaceutical composition is administered parenterally.
 4. The methodof claim 3 wherein, the pharmaceutical composition is administeredintravenously.
 5. The method of claim 1 wherein, the pharmaceuticalcomposition is a solid.
 6. The method of claim 1 wherein, thepharmaceutical composition is a liquid.
 7. The method of claim 1wherein, greater than about 50 mg/kg of body weight of thepharmaceutical composition of the salt of diphenyl barbituric acid isadministered.
 8. The method of claim 1 wherein, greater than about 70mg/kg of body weight of the pharmaceutical composition of the salt ofdiphenyl barbituric is administered.
 9. The method of claim 1 wherein,greater than about 100 mg/kg of body weight of the pharmaceuticalcomposition of the salt of diphenyl barbituric is administered.
 10. Themethod of claim 1 wherein, greater than about 250 mg/kg of body weightof the pharmaceutical composition of the salt of diphenyl barbituric isadministered.
 11. The method of claim 1 wherein, greater than about 500mg/kg of body weight of the pharmaceutical composition of the salt ofdiphenyl barbituric acid is administered.
 12. The method of claim 1wherein, greater than about 1000 mg/kg of body weight of thepharmaceutical composition of the salt of diphenyl barbituric acid isadministered.
 13. A method of administering a therapeutically effectiveamount for providing neuroprotection to a human in need thereof of apharmaceutical composition of a salt of 5,5-diphenyl barbituric acid,comprising administering to the human a salt of 5,5-diphenyl barbituricacid in a quantity sufficient to produce blood concentrations of5,5-diphenyl barbituric acid or an active metabolite thereof of at leastabout 30 μg/ml in the human, wherein the human is undergoing cardiacsurgery or carotid endartectomy, or has had an atrial fibrillation,transient ischemic attacks (TIAs), bacterial endocarditis, ischemicstroke, or subarachnoid hemorrhage due to a cerebral aneurysm.
 14. Themethod of claim 13 wherein, the amount of the pharmaceutical compositionof the salt of diphenyl barbituric acid administered is sufficient toproduce blood concentrations of diphenyl barbituric acid or an activemetabolite of at least about 50 μg/ml.
 15. The method of claim 14wherein, the amount of the pharmaceutical composition of the salt ofdiphenyl barbituric acid administered is sufficient to produce bloodconcentrations of diphenyl barbituric acid or an active metabolite of atleast about 100 μg/ml.
 16. The method of claim 15, wherein the amount ofthe pharmaceutical composition of the salt of diphenyl barbituric acidadministered is sufficient to produce blood concentrations of diphenylbarbituric acid or an active metabolite of at least about 1000 μg/ml.17. A method of providing a neuroprotectant to a human comprisingadministering a therapeutically effective amount of a pharmaceuticalcomposition of a salt of 5,5-diphenyl barbituric acid to the human,wherein the human is undergoing cardiac surgery or carotid endartectomy,or has experienced cerebral ischemia, a cerebral aneurysm, or headtrauma, and is at risk for atrial fibrillation, transient ischemicattack (TIA), bacterial endocarditis, ischemic stroke, head trauma orsubarachnoid hemorrhage.
 18. The method of claim 17 wherein, thepharmaceutical composition is administered orally.
 19. The method ofclaim 18 wherein, the pharmaceutical composition is administeredparenterally.
 20. The method of claim 19 wherein, the pharmaceuticalcomposition is administered intravenously.
 21. The method of claim 17wherein, the pharmaceutical composition is a solid.
 22. The method ofclaim 17 wherein, the pharmaceutical composition is a liquid.
 23. Themethod of claim 1, wherein the compound is administered before onset ofneuronal damage.
 24. The method of claim 1, wherein the compound isadministered therapeutically after onset of neuronal damage.
 25. Themethod of claim 1, wherein the neuroprotective effect diminishes, orprotects the subject from, neuronal damage caused by head trauma orcerebral ischemia.
 26. The method of claim 1, where the compound isadministered in conjunction with cardiac surgery or carotidendarterectomy.
 27. The method of claim 1, wherein the human has had anatrial fibrillation, a transient ischemic attack (TIA), bacterialendocarditis, an ischemic stroke or subarachnoid hemorrhage.